Teaching Video Neuro Images : Faciobrachial dystonic seizures

A 58-year-old man had a 6-month history of daily brief (5–10 seconds) jaw-pulling and arm-flexion episodes (video 1 on the Neurology ® Web site at [Neurology.org][1]). At-home videos were interpreted as “stress-induced” (video 2). These stereotypical episodes with altered awareness lacked electrographic correlate or any abnormalities on brain MRI, as previously reported.1 The clinical diagnosis of faciobrachial dystonic seizures was supported by elevated voltage-gated potassium channel antibodies (4.11 nmol/L) and positive LGi1 (leucine-rich glioma inactivated-1) protein. Methylprednisolone and plasmapheresis abolished the episodes. Recognition of faciobrachial dystonic seizures is important to reorient treatment from antiepileptics (ineffective) to immunotherapy, preventing progression to cognitive impairment.1–3 Besides pathognomonic ipsilateral face–arm contractions (figure), our patient manifested unilateral and alternating face-only episodes. The authors thank Marcia Hartsock, MA, CMI, for creating the figure. [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000002359